Impact of Family History on Prostate Cancer Mortality in White Men Undergoing Prostate Specific Antigen Based Screening

PURPOSE: We assessed whether prostate cancer screening would decrease prostate cancer mortality in white men with a family history of prostate cancer. MATERIALS AND METHODS: Data from the PLCO cancer screening trial were used to compare the screening and usual care arms in the subset of men with and without a family history of prostate cancer. Univariate and multivariate Cox regression analysis, and log rank analysis of Kaplan-Meier curves were done to examine the data for differences in prostate cancer specific survival. RESULTS: A total of 65,179 white subjects were included in the prostate specific antigen screening trial, of whom 7,314 (11.2%) were diagnosed with prostate cancer. Only 4,833 white men (7.4%) had a family history of prostate cancer. Those with a positive family history had a significantly higher incidence of prostate cancer (16.9% vs 10.8%) and higher prostate cancer specific mortality (0.56% vs 0.37%, each p <0.01). On multivariate analysis this trended toward significance (HR 1.47, 95% CI 0.98-2.21, p = 0.06). Screening in men with a positive family history also showed a trend toward decreased prostate cancer specific mortality (HR 0.49, 95% CI 0.22-1.1, p = 0.08) and decreased time to death from prostate cancer (log rank p = 0.05). CONCLUSIONS: White men with a family history of prostate cancer are at increased risk for being diagnosed with and subsequently dying of prostate cancer. Yearly digital rectal examination and prostate specific antigen testing may decrease prostate cancer death in these individuals.